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HomeMy WebLinkAboutCO 11CITY OF RENTON Public Works Department CHANGE ORDER NO. 11 CONTRACT CHANGE ORDER AGREEMENT CONTRACT: South Lake WA Roadway Improvements (Garden Ave. Widening) CAG -12 -021 CONTRACTOR: ICON Materials DATE: February 20, 2013 C.0411 Page 1 of 1 SUMMARY OF PROPOSED CHANGE: Reason /Justification: On the morning of October 18, 2012, it was determined throw estigations by the City of Renton maintenance staff that a laterial connection across Garden Ave. N. was blocked and was the reason for ponding of storm water runoff at the existing catch basin at approximately Station 47 +10 Garden Ave. N. (LT). The invert of this 8 -inch lateral line running was too low to route into the new storm drain collection system located at the new gutter line on the east side of Garden Ave. N. The City of Renton concurred that the most practical solution is to install a new concrete inlet just west of the new gutter line with a solid cover and extend the 8 -inch inlet line into this structure and then intercept the 8 -inch CMP line draining to the NW. Additional sawcutting and replacement of new /existing concrete pavement was required to connect to these pipes. Per Field Directive #5, the Contractor was directed to proceed with this solution. This additional work was tracked on daily time and materials sheets and forms the basis for a lump sum price, including labor, materials, and equipment. Contract Change: Install a new concrete inlet with a solid cover, extend the 8 -inch inlet line, intercept the 8 -inch CMP line draining to the NW, sawcut and replace new /existing concrete pavement. Add new oav items for the followino quantities in the schedule of orices Item Approx Units ESTIMATED CONTRACT TOTAL AFTER CHANGE Unit Price Amount $12,272.07 $2,008,414.16 I Description No. Quantity 110A 1 1 1 LS lGarden Ave Drainage Connection Revision 1 $ 11 207.37 1 $ 11 207.37 Subtotal: $ 11,207.37 Washington State Sales Tax (9.5 %): $ 1,064.70 Total this Change Order (Subtotal Plus Sales Tax): $ 12,272.07 Working Days: 2 Additional Working Days are Granted to complete this work All work, materials and measurement to be in accordance with the provisions of the Standard Specifications and Special Provisions for the type of construction involved. ORIGINAL CONTRACT AMOUNT CURRENT CONTRACT AMOUNT ESTIMATE NET CHANGE THIS ORDER ESTIMATED CONTRACT TOTAL AFTER CHANGE $1,968,690.65 $1,996,142.09 $12,272.07 $2,008,414.16 , NATl1RF-S* Field Dire> tine South lake WA Roadway ( NIA Field Directive Description Garden Ave. Drainage Connection Revision ICON Materials - PaP t�t Avenue South, Suite 3001 Seattle, WA 981041 PH: 206.436.0515 FAX: 206A36.0516 TI8 Number — Date - P- 102(014) -1 1 Of 1 8/2012 1 Feld Directive No. J 005 Date 1 On the morning of October 18, 2012, It was determined through investigations by the City of Renton maintenance staff that a laterial connection across Garden Ave. N. was blocked and was the probable reason for ponding of storm water runoff at the existing catch basin at approximately Station 47+ 10 Garden Ave. N. (LT). It was previously thought that runoff collected at this structure was routed north and then east across Garden Ave. N. at Sta. 47 +52 into the 54 -inch storm drain line. Instead, the 8- inch line was routed over to a concrete inlet on the east side of Garden Ave. N. (that was removed per the Contract Plans) and then outfalled NW into the 54- Inch storm drain line via a CMP pipe. (8 -inch diameter). The invert of this 8-inch lateral. line running across Garden Ave. N., near the east gutter line, is too low to route into the new storm drain collection system located at the new gutter line on the east side of Garden Ave. N. Freshly poured concrete was removed to expose the pipes and a site meeting was held at approximately 12:45 PM today to resolve the Issue. Richard Marshall from the City of Renton concurred that the most practical solution Is to install a new concrete inlet just west of the new gutter line with a solid cover and extend the 8 -inch inlet line into this structure and then intercept the 8 -inch CMP line draining to the NW. Additional sawcutting and replacement of new /existing concrete pavement will be required to connect to these pipes. The Contractor is directed to proceed with this solution, tracking It as Force Account work. The Contractor shall provide pictures of the connection prior to bacldiilling and also asbuilt measurements /sketch for transmittal to the City project manager. Projem.�ngineer (or Representative) Date /v // ,F/1Z -- Time & Materials Tracking Project: Fed Aid No.: TIB No.: Work Performed By: Work Authorized By: Description of Work / Location : South Lake Washington Roadway Improvements (Garden Avenue Widening) Project No. CAG 12 -021 9 -P- 102(014) -1 ICON Materials PRIME Z­ Pert Date of Work: 10/18/12 FNR No.: CO #11 Weather: Kurt Ahrensfeld. Resident Engineer Bid Item: NONE DOCUMENTING DISPUTED WORK - signature does not constitute payment Work related to Fiedl Directive #5 - correction of a lateral storm drain line across Garden Avenue. 10/18: Remove wet c/c & expose ends of demo pipe to the west & north, order materials. LABOR Time Rates COST ID No. Name Classification REGULAR OVERTIME REGULAR OVERTIME 5 Christine Deyoung Foreman (Oper Grp 1a) 3.0 $ 59.27 $ 80.59 $ 177.81 9 Shane Morris Operator (Grp 2) 3.0 $ 56.37 $ 76.23 $ 169.11 2 Jason Betzer Operator (Grp 2) 3.0 TOTAL SERVICE with OH /P and WSST $ 56.37 $ 76.23 $ 169.11 10 Cody Vickers Operater 65% (Grp 3) 3.0 TOTAL MATERIALS with OH /P and WSST $ 42.15 $ 54.90 $ 126.45 14 Trevor Walker Apprentice 3.0 Overhead /Profit on Equipment at 21% $ 31.88 $ 42.48 $ 95.64 11 Joseph Jewitt Operator (Grp 3) 3.0 $ 55.88 $ 75.51 $ 167.64 8 Christopher Kolaski General Laborer (Grp 3) 3.0 $ 46.01 $ 63.68 $ 138.03 $ Subtotal- Labor $ 1,043.79 Overhead /Profit on Labor at I ": ";'29% s $ 302.70 TOTAL LABOR with OH /P $ 1,346.49 EQUIPMENT Time Hourly Rates COST ID No. Year, Make Model, Power... Blue Book Description REGULAR STANDBY REGULAR STANDBY 31.5607 2012 Takeuchi TB250 Crawler Mounted Compact Excavators 3.0 $ 25.52 $ 6.21 $ 76.56 23.559 2012 Case 521E Loader Wheel Loader 3.0 $ 43.48 $ 130.44 51.0072 2006 Ford F550 Dump Truck On- Highway Rear Dump 3.0 TOTAL SERVICE with OH /P and WSST $ 40.84 $ 4.97 $ 122.52 Overhead /Profit on Materials (including Sales Tax) at 21 V. $ TOTAL MATERIALS with OH /P and WSST $ $ Subtotal- Equipment $ 329.52 Overhead /Profit on Equipment at 21% $ 69.20 TOTAL EQUIPMENT with OH /P $ 398.72 MATERIALS Supplier Description From INV. # QTY UNIT $ COST Subtotal - Service $ Sales Tax on Subtotal Service at n/a (DOR Rule 170) $ Subtotal - Materials 21% j $ TOTAL SERVICE with OH /P and WSST Sales Tax on Subtotal Materials at n/a (DOR Rule 170) $ - $ Overhead /Profit on Materials (including Sales Tax) at 21 V. $ TOTAL MATERIALS with OH /P and WSST $ SERVICE Name Description Prime Contractor Markup (If Work Performed by Subcontractor) Rate: 12% INV. # COST $ 1,745.21 Subtotal - Service $ Sales Tax on Subtotal Service at n/a (DOR Rule 170) $ Overhead /Profit on Service (including Sales Tax) at 21% j $ TOTAL SERVICE with OH /P and WSST $ - Cumulative Subtotal - THIS PAY TICKET I $ 1,745.21 Prime Contractor Markup (If Work Performed by Subcontractor) Rate: 12% N/A TOTAL FORCE ACCOUNT COST - THIS PAY TICKET - Including all Markups $ 1,745.21 Record of WorklPa� Performed �j � Jgo , 5D i Party #1 - Describe In detail the work performed and basis for entitlement including applicable Contract Provisions. Use one sheet per workday. Use additional sheets if required. Date 1 I S M T W T F S MATERIALS USED -. S[!!�l'!-LI ' , "-7 I MEN © �' r m- ' MATERIALS USED -. I MEN _ Work Observed By (Party #2): signnwm4: '�. ��-/ _y/ Work Performed By (Party #1) Date: Date: F] Project Owner ICON Materials Other: copy of applicable written directive x, e-mail. letter). Nb IV1UC71 It e SIgnatum Signatures on this document may be relied upon by all parties to be those of authorized persons on behalf of Party 01 and Parry #2. This Record of work Performed if signed by Party #2 documents: (1) Work completed by Party #1 at the direction of Party #2 as described in detail hereon ONLY: and (2) Party #2's receipt of Notice of same. If both parties agree that the work described Is In addition to the Contract, Party #2 shall sign below. Absent the second signature of Party #2, both parties shall consider such work to be protested and must follow applicable Contract Specifications. This document in no way establishes entitlement to additional time. Party #1shall provide all documentation as required by the terms of the Contract to request or be granted additional time. Work Authorized for Change Order (Party #2) swnat�a Date: I hereby authorize Party #1 to perform the described work as 5n addition to the Contract. Upon receipt of the required Invoices a Change Order will be issued to compensate for this work. This is not an authorization of additional time and does not modify the terms of the Contract. Record of Work Panic". ed_Rev_20080521.4s; Time & Materials Tracking Project: Fed Aid No.: TIB No.: Work Performed By: Work Authorized By Description of Work / Location : Z Perteet 505 Fifth Avenue South, Suite 3001 Seatde, WA 98104 1 PH: 206.436.0515 FAX: 206.436.0516 South Lake Washington Roadway Improvements Date of Work: 10/19/12 (Garden Avenue Widening) Project No. CAG 12 -021 CO #11 9 -P- 102(014) -1 FNR No.: ICON Materials PRIME Weather: Kurt Ahrensfeld, Resident Engineer Bid Item: NONE DOCUMENTING DISPUTED WORK - signature does not constitute payment related to Field Directive #5 - correction of a lateral storm drain line across Garden Avenue. 10/19: Grade, expose existing pipe, set Type I catch basin & mud. LABOR Time Rates COST ID No. Name Classification REGULAR OVERTIME REGULAR OVERTIME 5 Christine Deyoung Foreman (Oper Grp 1a) 8.0 1.0 • $ 59.27 $ 80.59 $ 554.75 9 Shane Morris Operator (Grp 2) 6.5 12.5 $ 56.37 $ 76.23 $ 366.41 2 Jason Betzer Operator (Grp 2) 8.0 14.5 $ 56.37 $ 76.23 $ 450.96 10 Cody Vickers Operater 65% (Grp 3) 6.5 1.001 $ 42.15 $ 54.90 $ 273.98 14 Trevor Walker lAppre ntice 1 6.5 1 1 $ 31.88 $ 42.48 $ 207.22 8 Christopher Kolaski lGeneral Laborer (Grp 3) 8.0 1 1.5 1 $ 46.01 $ 63.68 $ 463.59 $ 1,213.98 $ Subtotal - Labor $ 2,316.91 Overhead /Profit on Labor at $ 671.90 TOTAL LABOR with OH /P $ 2,988.81 EQUIPMENT Time Hourly Rates COST ID No. Year, Make Model, Power... Blue Book Description REGULAR STANDBY REGULAR STANDBY 1.00 31.5607 2012 Takeuchi TB250 Crawler Mounted Compact Excavators 12.5 Delivered $ 25.52 $ 6.21 $ 319.00 23.559 2012 Case 521E Loader Wheel Loader 12.5 9936219 $ 43.48 16.99 $ 543.50 51.0072 2006 Ford F550 Dump Truck On- Highway Rear Dump 14.5 1.00 $ 40.84 $ 4.97 $ 592.18 8" cone x Cl coupling femco, 8" DI coupler, 8" gi Delivered 13250196 1.001 372.43 372.43 $ Subtotal - Equipment $ 1,454.68 Overhead /Profit on Equipment at 21 % i $ 305.48 TOTAL EQUIPMENT with OH /P $ 1,760.16 MA 1 CKIALJ Supplier Description From INV. # QTY UNIT $ COST Shope Concrete Products Type 1 Catch Basin Delivered 9936621 1.00 97.65 97.65 Shope Concrete Products Type 16" riser, #19 monument 1.5' paving ring Delivered 9936649 1.00 88.51 88.51 Shope Concrete Products 6 bags fast patch grout Delivered 9936219 6.00 16.99 101.94 HD Fowler Company 8" AC x Cl Coupling Fernco & sediment insert Delivered 13249993 1.00 342.76 342.76 HD Fowler Company 8" cone x Cl coupling femco, 8" DI coupler, 8" gi Delivered 13250196 1.001 372.43 372.43 Subtotal - Materials $ 1,003.29 Sales Tax on Subtotal Materials at n/a (DOR rule 170) ": $ - Overhead /Profit on Materials (including Sales Tax) at 21% $ 210.69 TOTAL MATERIALS with OH /P and WSST $ 1,213.98 I-] MI :ci L-1 Name Description Prime Contractor Markup (If Work Performed by Subcontractor) Rate: INV. # COST Best Parking Lot Cleaning Eductor & Operator, 4.5 hours 10/19/12 V119829 $ 946.25 Efate Construction Sawcut 25 LF of 11" c/c slab, 10/19/12 3072 $ 250.00 Subtotal - Service $ 1,196.25 Sales Tax on Subtotal Service at n/a (DOR rule 170) $ - Overhead /Profit on Service (including Sales Tax) at 21% j $ 251.21 TOTAL SERVICE with OH /P and WSST $. 1,447.46 Cumulative Subtotal - THIS PAY TICKET Is 7,410.41 Prime Contractor Markup (If Work Performed by Subcontractor) Rate: I N/A TOTAL FORCE ACCOUNT COST - THIS PAY TICKET - Including all Markups I $ 7,410.41 Record of Work � , �, A rz 0 r�n � Cn Performed Party #1 - Describe in detail the work per(gnned and basis for enfitlement ind�ng abpOmbM_ Conttacl previsions. Use are sheet per workday. Use additional sheets it 2� d. Date L ►L.? ^ 1 "t �7� -1 S M T W T (F S Equipment# Make Model Total Hours ADO tr cj, )•- A� Z a✓yrS V : Z t 71 1 - m� m� m� ON Equipment# Make Model Total Hours ADO tr cj, )•- A� Z a✓yrS V : Z t 71 1 - d02-r Un�5a`t _. Work Observed By (Party #2): Date: Work Performed By (Party #1,) Date: O .d - Party #1 Work Performed By Ftl b ICON Materials Other: %� fProject Owner M ICON Materials F] Other: ttach copy of applicable written directive -1-0e4 ape k 6R- tcA nt ekt5t7n pipe- :5 fie- i in U 51-r �Ma signatures on this document maybe relied upon by all parties to be (hose of authorized persons on behalf of Party #t -and Party #2. This Record of Work Performed if signed by, Parly #2 documents; (1) Work completed by Party #1 at the direction of Parry #2 as described in detail hereon ONLY; and (2) Party, #2's receipt of Notice of same. If both parties agree that the work descn'bed is in addition to the contract, Party #2 shall sign below. Absent the second signature of Party #2, both parties shall consider such work to be protested and must follow applicable Contract specifications. This document In noway establishes entitlement to additional time, Party #tshall provide all documentation as required by the terms of the Contract to- request or be granted additional time. Work Authorized for Change Order (Party #2) Date:s — �-- I hereby authorize Party #1 to perform the described work as an addition to the Contract. Upon receipt of the required Invoices a Change Orderwiil be Issued to compensate for this work. This is not an authorization of additional time and does not modify the terms of the Contract. Record of Work Performed_Rev_20080521.xis BEST PARKING LOT CLEANING INC P O BOX 159 SUMNER, WA 98390 Voice: 253- 863 -3330 Fax' 25'3 -770 -0724 Invoice Bill To: ICON MATERIALS INC Job Site: ATTN:ACCOUNTS PAYABLE PO BOX 3366 SPOKANE, WA 992203366 'OCT 2 G 2012 AC(( OUNTS PAYABLE Invoice N- .amber: V119829 Invoice Date: Oct 19, 2012 JOB #512301 PARK AVE N/ LOGAN AVE RENTON, WA Page: 1 Customer ID Customer PO Payment Terms Due Date ICOMAT- EXRP13 Net 30 Days — -- - —Hours 11/18/12 Job Slip # / Description Price Net — ED.UCTOR & OPERATOR JOB SLIP #91703 10/19/12 E-DUCI 4.75 19500 926.25 WATER CHARGE PER LOAD LOADE 1.00 10.00 10.00 FUEL SURCHARGE PER JOB SLIP <Each 1.00 10.00 10.00 TERMS: NET 30 DAYS MONTHLY FIN CHRG =1.75% PLEASE SHOW INVOICE NUMBER NTH YOUR PAYMENT ALL INVOICE DISPUTES MUST BE SUBMITTED IN WRITING PRIOR TO INVOICE DUE DATE Subtotal 946.25 Sales Tax Total Invoice Amount 946.25 Payment/Credit Applied TOTAL 946.25 EFATE CONSTRUCTION COMPANY 31017149TH AVENUE S.E. KENT, WA 98042 PHONE: 253.797.9045 FAX:253.630.1030 Ticket. r� bate: Bill To: Work [)one:— Job Address.: „ +_.,.� ; city: .',�► C Operator:". Qty. bescription of Work Per Unit Price Amo7nt Y r y.� r w. JL .O. Number 4`711 �-• Acknowledged rob No.. Company We do not assume responsibility for damage caused by cutting buried pipe, conduit, voids, wood and steel beams. All material is Guaranteed to be specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration, or leviotion from above specifications involving extra" costs will be executed only upon written orders, and will become an extra charge )ver and above the estimate. Late fees and legal fees will be added for accounts over 30 days past due. If this matter should proceed to collections, reasonable attorney fees and the cost of the suit will be added. shQj e Shope Concrete Products Company concrete 1products 1618 E Main INVOICE 9936621 Puyallup, WA 98372 Invoice Date: 10119/2012 Phone: (253) 8484551 Fax: (253) 845 -0292 L> F•iiy4j �i n - 1��'' Sold to: 1307 Job Number: 0 I I ICON MATERIALS Ship to: LAKE WASHINGTON i ACCO PO BOX 3 366 OCT PAYABLE OCT 3 0 2012 PO BOX 3 66UNTS PAYABLE SPOKANE, WA 99220 -3366 L SPOKANE, WA 99220 -3366 AP' 001JNTS PAYA91JE 10/19/2012 1 % 10TH, .N /11TH 1 •S,'I; • .: - c` �1.. :.,e�,•- .,•:��,:a� �:� -�` ..t.:,,•- :�-�,z.:.._ ,.3�•;, p��+,�,� p.�..p._E..ikt ,r,:J: ,1.:* *�t�_ -'. �t i �= '!i`:r'- ;�(!:� +�;i• • y�;� e; •iRa ,,: ��. . �.. .,y- •.-'a,�.,�.t,...ih.,......� _:..b .!:,�t'H:_;K� . . :... .,.�� .:nin 'id:f:T•_'•L .:'aY...:'.�_, 1C•;�i! 5.�� 1n•.;;i':v .i �ltu! N/A A161 11 9936621 Qty Item Description Unit Price TX Extension Structure: 1 CB1 B TYPE 1 CATCH BASIN $97.65 ❑ Structure Total $97.65 $97.65 Taxable Non Taxable $0.00 $97.65 Sub Total $97.65 Tax $0.00 Invoice Total $97.65 Less'Deposit $0.00 Invoice Balance $97.65 Page 1 sJ I /'l e Shope Concrete Products Company IIII��f( du 1618 E Main INVOICE 9936649 concrete products Puyallup, WA 98372 invoice Date: 10/2212012 Phone: (253) 948 -1551 Fax: (253) 845 -0292 (•_:' r- ,., ;.t, . ,'1?'; :.r Sold to: 1307 Job Number: 0 ICON MATERIALS Ship to: LAKE WASHINGTON ATTN: ACCOUNTS PAYABLE OCT 3 0 20t2 ATTN: ACCOUNTS PAYABLE PO BOX 3366 PO BOX 3366 SPOKANE, WA 99220 -3366 SPOKANE, WA 99220 -3366 ACCOUNTS PALPABLE i 10/22/2012 1% 1.0TH, N111TH 1 : 1s _..t._. ....... . , _.. i. `= -'...; �;� . .r:• .:.,< •. +1k;•�t:.;r:..a;;4�+:�'. '�^�. ..f- �.�,,_. r,�: f'°�',_+7. gi4�'h,•[1''_ ;'i i.: y`�-"'(r;+ _ N/A A16 3540 11 9936649_ _ QLy ttem Description Unit Price TX Extension 1 Structure: 2 CBIR6SS TYPE 16" RISER STATE STAMPED $29.90 ❑ $59.80 1 CAMCC19PR #19 MONUMENT 1.5" PAVING RING $28.71 ❑ $28.71 Structure Total $88.51 Taxable $0.00 Non- Taxable $88.51 Sub Total $88.51 Tax $0.00 Invoice Total $88.51 Less Deposit $O.OD Invoice Balance $88.51 Page 1 ,�k?pe Shope Concrete Products Company Products 1618 E Main INVOICE 9936219 Puyallup, WA 98372 Invoice Date: 10/3/2012, Phone: (263) 848-1551 Fax: (253) 845-0292 Sold to: 1307 Job Number. 0 [CON MATERIALS Ship to: ATTN: ACCOUNTS PAYABLE LAKEWASHINGTON BLVD & GARDEN AVE PO BOX 3366 II SPOKANE, WA 99220-3366 SEATTLE, WA rim. 10/3/2012 Greg 1% 10TH, WITH NIA A16 3540 11 1 9936219 —Description Qty I—tom—­– Unit Price TX Extension Structure: 56 DGFP FAST PATCH (I PALLET) $16.99 ❑ $951.44 - 41 11�' 160 t,& S C Structure Total $951.44 .......... ................ -------------------------- -------- -- --------------------- ------------- --------------- ------ -- ----------------------- ------- .................... ............. I .................. -- ------------------------------------ --------------------- OCT 10 2012 Taxable Non-Taxable $0.00 $951:44 ACCOUNTS PAYABLE Sub Total $951.44 Tax $0.00 Invoice Total $951.44 Less Deposit $0.00 Invoice Balance $951.44 Page 1 Corporate Offices 13440 SE 30th St., Bellevue, WA 98005 PO Box 160, Bellevue, WA 98009 -0160 H.D. FOWLER OCT 25 2012 Phone 425- 746 -8400 a Fax 425 -641 -8885 —�' COMPANY PO Box 160, Bellevue, WA 98009- 0 pqyA Pacific Branch Invoice � LSi17 Thornton Avenue SW Number 13249993 PAWN Pacific, WA 98047 # 193790 (253) 863 -8600 Fax (253) 863 -8681 To: Ship to: HD Fowler Company -Pacific 2/4 i�lll��' I' 1' I' �11�111�1' Illll�i�i 'll'�I��'��Iilllll�ll��ll 3 ICON MATERIALS INC Pacific WA 98047 Accounts Payable PO Box 3366 Order# Inv Date: Order Writer: Spokane WA 99220 -3366 04052716 10/19/12 MICHAEL OWENS Terms: NET 10TH PROX Due: 11/10/12 POIJOB: KRISTY FOB: H. D. FOWLER Ship Via: WILL CALL SOUTH LAKE WASHINGTON ROADW Qty Qty Part # Unit Extended T Line Ship'd BO'd UoM Description Price Price X 2 1 0 EA 8" AC X Cl COUPLING FERNCO #105188 21,210 21.21 1 5 0 EA CATCH BASIN SEDIMENT INSERT FOR STORM 64.310 321.55 DRAINS DRAINGUARD UDG009218 Sub total 342.76 Freight 0.00 Tax 0.00 Serving the Pacific Northwest since 1911 Grand Total 342.76 KRISTY www.hdfowler.com Corporate Offices 13440 SE 30th St., Bellevue, WA 98005 j'�j r 4�IL PO Box 160, Bellevue, WA 98009 -0160 H. D. FOWLER Phone 425- 746 -8400 - Fax 425- 641 -8885 COMPArA OUNTS PAYAF3t.L, PO Box 160, Bellevue, WA 98009 -0 Bellevue Branch i; —� 13440 SE 30th St invoice 13440 WA 98005 Number 13250196 BEWH' (425) 746 -8400 Fax(425)641 -8885 # 19379n To: Ship to: HD Fowler Company - Bellevue 4/4 Ilrrlll' rl�rlltlri�rll�nuiltll�lrlrlhllr���niulllr�ll�r�l 3 ICON MATERIALS INC Bellevue WA 98005 Accounts Payable PO Box 3366 Order# Inv Date: Order Writer: Spokane WA 99220 -3366 04052714 10/19/12 MICHAEL OWENS Terms: NET 10TH PROX Due., 11/10/12 PO /JOB: KRISTY FOB: H. D. FOWLER Ship via- WILL CALL SOUTH LAKE WASHINGTON ROADW Qty Qty Part # Unit Extended T Line Ship'd BO'd UoM Description Price Price X 1 1 0 EA 8" CONC X Cl COUPLING FERNCO #100688 21.210 21.21 4 20 0 FT 8716 GA GALVANIZED STEEL CULVERT,CMP,20 FT. 11020 260.40 LENGTH 5 1 0 EA 8" GALV STEEL COUPLING FOR CMP WITH BOLTS 28.410 28.41 AND NUTS 6 1 0 EA 8" CULVERT GASKET,7" WIDE FOR CMP 6.550 6.55 7 14 0 FT 8" PVC SEWER PIPE,GASKTED,ASTM D3034,14' 3.990 55.86 LENGTH Sub total 372.43 Freight 0.00 Tax 0.00 Serving the Pacific Northwest since 1911 Grand Total 372.43 KRISTY I www.hdfowler.com Time & Materials Tracking Project: Fed Aid No.: TIB No.: Work Performed By: Work Authorized By: South Lake Washington Roadway Improvements (Garden Avenue Widening) Project No. CAG 12 -021 9 -P- 102(014) -1 ICON Materials PRIME Z Perteet WA 98104 1 PH: 206.436.0515 FAX: 206.436.0516 Date of Work: 10/22/13 C0#11 FNR No.: Weather: Kurt Ahrensfeld, Resident Engineer Bid Item: NONE DOCUMENTING DISPUTED WORK - signature does not constitute payment ✓York related to Fiedl Directive #5 - correction of a lateral storm drain line across Garden Avenue. 10/22: BF - compact - wait for compaction testing - set frame & solid lid - remove steel sheet LABOR Time Rates COST ID No. Name Classification REGULAR OVERTIME REGULAR OVERTIME 1.00 5 Christine Deyoung Foreman (Oper Grp 1a) 3.0 Subtotal - Service $ 59.27 $ 80.59 $ 177.81 9 Shane Morris Operator (Grp 2) 3.0 Overhead /Profit on Service (including Sales Tax) at $ 56.37 $ 76.23 $ 169.11 2 Jason Betzer Operator (Grp 2) 3.0 $ 56.37 $ 76.23 $ 169.11 10 Cody Vickers Operater 65% (Grp 3) 3.0 TOTAL MATERIALS with OH /P and WSST $ 42.15 $ 54.90 $ 126.45 14 Trevor Walker Apprentice 3.0 Overhead /Profit on Equipment at 21 % 1 $ 31.88 $ 42.48 $ 95.64 11 Joseph Jewitt Operator (Grp 3) 3.0 $ 55.88 $ 75.51 $ 167.64 8 Christopher Kolaski General Laborer (Grp 3) 3.0 $ 46.01 $ 63.68 $ 138.03 Subtotal - Labor $ 1,043.79 Overhead /Profit on Labor at �''' �', 29% . >;,','? $ 302.70 TOTAL LABOR with OH /P $ 1,346.49 EQUIPMENT Time Hourly Rates COST ID No. Year, Make Model, Power... Blue Book Description REGULAR STANDBY REGULAR STANDBY 1.00 31.5607 2012 Takeuchi TB250 Crawler Mounted Compact Excavators 3.0 Subtotal - Service $ 25.52 $ 6.21 $ 76.56 23.559 2012 Case 521E Loader Wheel Loader 3.0 Overhead /Profit on Service (including Sales Tax) at $ 43.48 $ $ 130.44 51.0072 2006 Ford F550 Dump Truck On- Highway Rear Dump 3.0 $ 40.84 $ 4.97 $ 122.52 Overhead /Profit on Materials (including Sales Tax) at . 21%, j $ 53.20 TOTAL MATERIALS with OH /P and WSST $ 306.54 Subtotal - Equipment $ 329.52 Overhead /Profit on Equipment at 21 % 1 $ 69.20 TOTAL EQUIPMENT with OH /P $ 398.72 MATERIALS Supplier Description From INV. # QTY UNIT $ COST East Jordan Iron Works 20x24 frame & solid cover, locking Delivered 3545024 1.00 253.34 253.34 $ Subtotal - Service $ Sales Tax on Subtotal Service at n/a (DOR Rule 170) $ Overhead /Profit on Service (including Sales Tax) at �. .21 %. $ TOTAL SERVICE with OH /P and WSST Subtotal - Materials $ 253.34 Sales Tax on Subtotal Materials at n/a (DOR Rule 170) r , $ - Overhead /Profit on Materials (including Sales Tax) at . 21%, j $ 53.20 TOTAL MATERIALS with OH /P and WSST $ 306.54 SERVICE Name Description Prime Contractor Markup (If Work Performed by Subcontractor) Rate: ( 12% ) INV. # COST $ 2,051.75 $ Subtotal - Service $ Sales Tax on Subtotal Service at n/a (DOR Rule 170) $ Overhead /Profit on Service (including Sales Tax) at �. .21 %. $ TOTAL SERVICE with OH /P and WSST $ Cumulative Subtotal - THIS PAY TICKET I $ 2,051.75 Prime Contractor Markup (If Work Performed by Subcontractor) Rate: ( 12% ) N/A TOTAL FORCE ACCOUNT COST - THIS PAY TICKET - Including all Markups $ 2,051.75 Record of Work C(-� Lyn �� � i4 i l : c �� 1 Performed I 6, t-,7-D -:5Z015 Party #1 - Describe in detail the work performed and basis for entitlement including applicable Contract Promions. Use one sheet par workday. Use additional Sheets if required. Date I S /Ml T W T F S MATERIALS USED /00 - V Vescription E MIffirawnin �ffl min MATERIALS USED /00 - V Vescription Work Observed By (Party #2): S� Nr- �� Work Performed By (Party #1) Date: Date: Party #1 Work Performed By ICON Materials Other: 0--Project Owner ❑ ICON Materials n Other: copy of applicable written directive %rlu(�tGC-2 Signatures on this document may be relied upon byail parties to be those of authorized persons on behaffof Party #1 and Party 02, This Record of Work Performed if signed by Party #2 documents: (1) Work completed by Party #1 at the direction of Party #2 as described in detail hereon ONLY: and (2) Party #2's receipt of Notice of same. If both parties agree that the work described is in addition to the Contract. Party e2 shall sign below. Absent the second signature of Party e2. both parties shall consider such Work to be protested and must follow apperable Contract Specifications. This document in noway establishes entitlement to additional time. Party #1 shall provide all documentation as required by the terms of the Cwtmc( to request or be granted additional time. Work Authorized for Change Order (Party #2) Date: I hereby authorize Parry #1 to perform the described work as an addition to the Contract. Upon receipt of the required invoices a Change Order will be issued to compensate for this work. This is not an authorization of additional time and does not modify the terms of the Contract. Record of Work Performed Rev_20080521.xis J$0%lilt ej EJ USA, Inc PO Box 644873 ".14 O" r Pittsburgh, PA 15264-4873 OCT 2 9 2012 SOLD TO:':"1`ni.�t+17!5 Pr�►vA.i34_ 67061 MB 0.404 E0178X 10282 0569560689 Pl220926 0001 :0001 fill �fl�f ��u�u' r����uutli�tUr�rtl�lrlyl�ll�urtu�l�i� SHIPPED TO: r;.W ICON MATERIALS- TUKWILA Icon Materials - Tukwila division of Oidcnsile PO BOX 3366 Loaves Parkin Lot 9 SPOKANE WA 99220.3366 1000 Garden Ave North Customer Number Renton, WA 98057 INVOKE Invoice:Num6er 3545024 Ihvtilce -bale 10/23/12 Invoice Due- 11/22/12 Omer Number 3545024 Customer Number 4348 Ship Date 10/22112 Shipper Location 410 Page Number 1 of 1 Customer P.O. Number Job Name ,:: Job Number ,Sale's Branch Shipping Method 512301 Pacific Yard I YARD I Northwest Branch Our Truck Linn Product Number /Description UM Quantity; Unit Price Extended Amount' 1 00777024B01 77702 7770A BLT2 WSDOT 830,20 ASY EA 1 203.34 203.34 20X24 FRAME & SOLID COVER, LOCKING EJ is transitioning to electronic delivery of all customer invoices. Please provide the email address or fax number where your invoices can be delivered This information, along with your customer number, should be emailed to Americas.ar@ejco.com or faxed to 231.836.4619. Thank you. A monlhly FINANCE CHARGE will be addeyd topany unpaid balance whhich Is nol pald when due. (from and after thCHARGES uo date) which an ANNUAL PERCENTAGE RATE OF 18Y. 8 %applied to tho unpaid balances after deducting payments made before the due dates andlor credits. Payments received on account are applied against the amounts first due, We hereby certify that these goods were produceil In compliance with all upplicabie requirements of Sec. 6, 7, & 12 61 the Fair Labor Standards Act, as amended, and ofregulefflons and orders of the United States Department of tabor issued under Sec. 14 thereof. 0001:0001 Ed USA, Inc. Terms & conditions apply ejco.com 600 620 4653 Ririilt Paymont To; Amount 203.34 EJ USA, Inc. P O BOX'644873 PITTSBURGH, PA 15264 -4873 Tax 0.00% .00 Freight 50.00 Total Due 253.34